Individual
MATTHEW A JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2323 MEMORIAL AVE, SUITE 10, LYNCHBURG, VA 24501-2661
(434) 200-5200
Mailing address
1204 FENWICK DR, LYNCHBURG, VA 24502-2112
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
0101057967
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
005614023
—
VA
01
—
080154922
MEDICARE RAILROAD PROVIDER NUMBER
—
01
—
119865
ANTHEM
—
Enumeration date
11/17/2005
Last updated
10/24/2011
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